Provider Demographics
NPI:1013694298
Name:LAYLOR, GENOLYN LUCILLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GENOLYN
Middle Name:LUCILLE
Last Name:LAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14917 85TH DR
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2812
Mailing Address - Country:US
Mailing Address - Phone:917-480-8388
Mailing Address - Fax:
Practice Address - Street 1:6355 102ND ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2680
Practice Address - Country:US
Practice Address - Phone:718-830-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional